Many Faces of Cancer. One Center for Hope.

2011 CANCER PROGRAM ANNUAL REPORT 2011 ANNUAL CANCER REPORT · 2010 STATISTICAL REVIEW

Many Faces of Cancer. One Center for Hope. Table of Contents President’s Message 

3

2011 Cancer Committee 

4

Cancer Committee Chair’s Message 

5

Cancer Liaison’s Message 

6

Cancer Conferences 

7

Breast Cancer Treatment Options 

8

Cancer Resource Library 

9

Focus on Art 

9

Message from the Registry 

10

Cancer Primary Site Table 

11

Top 5 Site Distribution 

12

2010 Estimated Performance Rates 

12

Breast Cancer Data Review 

2

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Many Faces of Cancer. One Center for Hope. President’s Message Today, a friend of mine enjoys life with her family and works hard in her career because she was one of the 55 percent of women who have regular mammograms. When she was diagnosed, her whole family faced this challenging time with her. She courageously began radiation and chemotherapy treatments with the support of the Florida Hospital Waterman Cancer Institute and now celebrates five years of being cancer free. I am so grateful for the medical scientists: physicians, physicists, chemists and computer engineers, who have made her recovery possible from this destructive disease threatening our daughters, wives, mothers, and sisters. If you’ve driven past Florida Hospital Waterman during October you may have noticed a few changes. In honor of Breast Cancer Awareness Month the water in our fountain flows pink and our atrium roof glows pink in the dark. Our “pinking” of the fountain has become an annual community event uniting us in the fight for the cure. During the ceremony breast cancer survivors, doctors, nurses, administrators and chaplains speak about the successes and challenges of saving and rebuilding lives ravaged by this disease. October is a time of reflection, remembering those we have lost, a time of celebration for those who have survived, and a time of hope as we hear of new discoveries bringing us closer to a cure. It is our goal to continue providing the very best care through our qualified, compassionate physicians and clinical staff supported by the latest equipment, while we fight with those attacked by this enemy. May God help us in this life-saving work! Ken Mattison President/CEO

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Many Faces of Cancer. One Center for Hope. 2011 Cancer Committee The Cancer Committee is the leadership body responsible for developing, implementing, evaluating and improving all cancer related activities in our program and community. The committee meets quarterly and represents physicians from radiology, pathology, medical oncology, radiation oncology and surgery as well as allied health care, administrative and supportive services professionals.

Ahmed Al-Hazzouri, MD, Oncology/Hematology Gary Allen, MD, Thoracic Surgery Marcus Bethea, MD, Pathology Jeffrey Brabham, MD, Radiation Oncology Michael Freedman, DO, Otolaryngology Maen Hussein, MD, Oncology/Hematology Ralph Gousse, MD, Oncology/Hematology Peter Marzek, MD, Plastic Surgery Borys Mascarenhas, MD, Surgical Oncology Robert Purdon, MD, Radiation Oncology Rambabu Tummala, MD, Hematology/Oncology Rohan Watson, MD, Radiology Lou Acuff, Hospice, Lake County James Barnes, Director, Pharmacy Stephanie Bassett, Clinical Dietitian Gina Becker, ACS Melissa Chase, RN - Nursing Jennette Cox, CTR - Cancer Registry Coordinator Fran Crunk, Vice President/Chief Financial Officer Patricia Dolan, VP/Chief Nursing Officer

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Sterling Elder, Operations Manager Dana Ikensaa, Clinical Liaison, Hospice Carrie Fish, Sr. Vice President/Chief Operating Officer Renee Furnas, Marketing Rick Golab, Director, Cancer Center/ Diagnostic Imaging Mary Johnson, Quality Management April Kauffman, Florida Hospital Waterman Foundation Barbara Lane, RN, BSN, OCN - Clinical Research Nurse Becky Longanecker, Director, Professional Services Karen Mathias, Director, Medical Records Ken Mattison, President/Chief Executive Officer Susan Moore, Director, Home Care Services Faye Rose, Director, Pastoral Care Evadne Tsolo, MSW - Social Worker Jennifer Sanky, CTR - Cancer Registry Pamela Smith, Rehabilitation Services

Many Faces of Cancer. One Center for Hope. Cancer Committee Chair’s Message Dear Friends, This year marked another successful chapter in the story of Florida Hospital Waterman Cancer Institute. In this annual report, you will find a review of the comprehensive set of services that we are proud to offer to the cancer patients of Lake County and beyond. Jeffrey G. Brabham, M.D.

A focus of this year’s annual report is breast cancer. Breast cancer is the most frequently diagnosed cancer in women; this year alone, it is expected to affect the lives of over 230,000 women in the United States. Not surprisingly, breast cancer also comprises a significant portion of our caseload at Florida Hospital Waterman Cancer Institute. In response to its frequency as well as the special needs of breast cancer patients, we have developed a specific breast cancer program. Highlights of this program include a breast care coordinator and prospective presentation of all new breast cancer patients in our weekly multidisciplinary cancer conference. We have also reviewed the data and published outcomes from our own breast cancer experience. I am proud to say that these results confirm our ability to offer world-class cancer care here in Lake County. Also, I would be remiss if I did not take this opportunity to acknowledge the dedicated physicians, staff, and volunteers of Florida Hospital Waterman Cancer Institute for their tireless efforts to ensure that our patients have the best care experience possible. Our people are our greatest differentiator and most important asset. Cancer care is our passion, and I hope that this fact shines through the pages of this report. Sincerely, Jeffrey G. Brabham, M.D. Chair, Florida Hospital Waterman Cancer Committee

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Many Faces of Cancer. One Center for Hope. Cancer Liaison’s Message Last year was challenging and exciting for the cancer program at Florida Hospital Waterman Cancer Institute. Though the annual report summarizes the achievements, it cannot accurately describe the sweat and blood invested by the wonderful people making this program successful.

Maen Hussein, MD Cancer Liaison Physician

The Commission on Cancer liaison program was developed as a grassroots network of physician volunteers willing to work together to manage cancer activities in their local institutions and surrounding communities. They are also responsible for providing leadership and direction to establish, maintain and support their facility cancer program. I have been the liaison for the last four years. During this time there have been many challenges, but also many achievements. These achievements wouldn’t have been possible without the other physicians, nurses and staff caring for cancer patients in the community. Our research program, which began in 2007, continues growing as part of the Florida Cancer Specialist and Research Institute clinical trials program. We are proud to be part of trials leading to FDA approval of new cancer therapies. Our research program and involvement in clinical trials provides our patients with state-of-the-art therapy for many different cancers. Another achievement, our rehabilitation for cancer patients, includes physical therapy and lymphedema therapy. We are also training nurses in oncology to advance our inpatient oncology services. In collaboration with local hospice providers, we are working to raise the awareness of palliative care and ease the accessibility for patients in need. A continuing success, our social work program offers support group meetings in addition to helping patients get financial and psychological/emotional support during their journey fighting cancer. This year the research program renewed its accreditation from the American College of Surgeons, Commission on Cancer for three years. The program was recognized for the care provided to cancer patients.

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Many Faces of Cancer. One Center for Hope. Cancer Conferences

Gary Allen, MD, FACS Cardiothoracic Surgery

A cancer diagnosis and the prospect of treatment can be both frightening and confusing. While it may feel natural to talk about your diagnosis and treatment with other cancer patients and survivors, it can be intimidating to question the surgery and treatment plan proposed by your doctor. Many people diagnosed with cancer accept their physician’s recommendation without seeking a second opinion. Wouldn’t it be great to get an automatic second opinion or better yet, the opinion of multiple experts? Patients at Florida Hospital Waterman Cancer Institute benefit from an integrated team of specialists who meet formally as a multidisciplinarytumor-board. The team meets every week, bringing together medical experts from different specialties to review and discuss patients’ medical conditions and treatment options. At Florida Hospital Waterman Cancer Institute these specialists include surgeons, oncologists, radiologists, pathologists, nutritionists, oncology nurses, dosimetrists and a social worker. This is an enormous added benefit for our patients. The interaction between these specialists allows us to make personalized treatment plans for each cancer patient. Our multidisciplinary approach offers highly comprehensive, coordinated cancer care for even the most complex cancers, giving our patients peace of mind knowing their care has the endorsement of multiple experts.

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Many Faces of Cancer. One Center for Hope. Breast Cancer Treatment Options

Borys Mascarenhas, MD, FACS Surgery

Surgery is often a treatment option frequently used by patients diagnosed with cancer. Surgery may also be combined with other treatments such as hormone therapy, chemotherapy, biological therapy and radiation therapy. Florida Hospital Waterman Cancer Institute offers a team of boardcertified surgeons with expertise in surgery for cancer. Additionally, I am the only fellowship-trained surgical oncologist in Lake County. Our surgical specialists provide state-of-the-art care in a private-practice setting ensuring patients receive individualized care. Named a “Center of Excellence” in accelerated partial breast irradiation (APBI), Florida Hospital Waterman Cancer Institute uses the SAVI® (strut adjusted volume implant), an advanced therapy for breast cancer, as part of breast conservation therapy. An alternative to mastectomy, (which removes the entire breast and often followed by breast reconstruction) breast conservation therapy includes lumpectomy, (the surgical removal of the cancer plus tissue immediately around the tumor) followed by radiation therapy. An alternative to traditional radiation, the SAVI® targets the tumor site from inside the breast. Inserted into the lumpectomy cavity through a small incision, the multi-catheter SAVI® treats the tissue surrounding the lumpectomy cavity from the inside out with the radiation dose customized by the radiation oncologist to the size and shape of the area to be treated. Typically involving only two treatments per day over five days, APBI is far more convenient than traditional external-beam radiation, which is delivered five times per week for six or seven weeks. In addition, APBI minimizes radiation exposure of healthy tissue such as the skin, heart, lungs and ribs.

Did you know Florida Hospital Waterman Cancer Institute is among the first cancer centers in the United States to offer SAVI®?

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Technology makes it possible for us to provide more women with the advantages of APBI. Through our high care volume and excellent clinical outcomes I was fortunate enough to earn a Distinguished Achievement Award for excellence in APBI.

Many Faces of Cancer. One Center for Hope. Cancer Resource Library From the moment of diagnosis, cancer patients are faced with physical, spiritual, emotional and financial challenges. Understanding patients have questions about their cancer diagnoses, Florida Hospital Waterman Cancer Institute offers the Cancer Resource Library. Providing appropriate, no-cost information, the library is an important way to address any questions or needs. Volunteers staff the library and provide assistance to anyone who walks through our doors. Through the library, patients, families and the Central Florida community have access to books, DVDs and pamphlets on cancer, diagnosis, treatments, side effect management, coping, self-esteem and cancer prevention. Obtained from a variety of sources, these materials are carefully screened by healthcare professionals. Through the CancerHelp® interactive computer users have easy access to the latest information from the National Cancer Institute. Bilingual materials are also available. The Cancer Resource Library also provides materials for community health fairs, public and private school education, and nurse and doctor conferences. All of these services are provided to the Central Florida community free of charge. OBJECTIVES • Serve patients, family members, doctors, staff, student education programs, and the community • Provide accurate and timely information ensuring patients are able to make educated treatment decisions • Educate patients about healthcare choices making them an integral part of their treatment planning while helping improve their quality of life during treatment • Increase knowledge among patients raising their chances of optimal outcomes • Increase cancer prevention awareness among patients, their families and the general public • Eliminate any cost to patients and provide access to all regardless of their economic station

Focus on Art On Tuesday mornings Florida Hospital Waterman Cancer Institute offers live art in the lobby giving cancer patients inspiration and diversion from the difficulty of their health issues. During the art sessions our chaplain discusses art therapy and often leads patients in prayer. Drawing Others to Him: Patient Testimonies One Tuesday, a retired law enforcement officer and his wife stood speechless, looking at a piece of art depicting a Christmas angel. Having seen much trauma out on the streets during his career, he wanted a copy of the piece to frame at home as a reminder of how protected he was during his years of service, and now during his illness, to have faith. Another patient’s battle against cancer resumed after 10 years of remission and the fight was taking its toll emotionally. “She isn’t a complainer, she’s been such a trooper,” her husband said. After watching the artist, something inside her began to change. Later that night she finally cried out to God and the next week she came into Florida Hospital Waterman Cancer Institute beaming. She felt so much better and was encouraged and strengthened.

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Many Faces of Cancer. One Center for Hope. Registry The Cancer Registry at Florida Hospital Waterman Cancer Institute maintains a computerized database to collect, manage and analyze our cancer patients’ information. Data is submitted to both the Florida Cancer Database and the National Cancer Databases (NCDB). Compiled with data from both the state and the nation for statistical analyses, cancer registries throughout the United States are able to conduct comparative studies on survival rates, incidence occurrence, prevalence and populations. In 2011, a total of 901 cases were accessioned in the Cancer Registry at Florida Hospital Waterman Cancer Institute, which included 439 male patients and 444 female patients. Of these cases 668 were analytic (diagnosed and/or treated at Florida Hospital Waterman Cancer Institute), 218 were non-analytic (diagnosed and treated elsewhere before coming to Florida Hospital Cancer Institute with recurrent or persistent disease). The registry currently maintains a 90 percent followup rate for analytic patient accessioned in the last five years and an 89 percent overall follow up rate. For more information please contact Jennette Cox at (352) 253-3611, email: [email protected] or Jennifer Sanky at (352) 253-3613, email: [email protected]

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Many Faces of Cancer. One Center for Hope. Cancer Primary Site Table 2010 FHW Primary Site Table

Total

Class A

Sex M

F

0

I

II

III

IV

UNK

All Sites 901

688

213

455

466

37

191

187

100

167

58

161

Oral Cavity 22 Lip 0 Tongue 5 Oropharynx 0 Hypoharynx 1 Other 16 Digestive System 137 Esophagus 12 Stomach 8 Colon 43 Rectum 23 Anus/Anal Canal 3 Liver 14 Pancreas 25 Other 9 Respiratory System 179 Nasal/Sinus 0 Larynx 11 Lung/Bronchus 168 Other 0 Blood & Bone Marrow 103 Leukemia 35 Multiple Myeloma 22 Other 46 Bone 1

20 0 4 0 1 15 110 8 8 35 19 2 8 22 8 162 0 10 152 0 45 12 10 23 1

2 0 1 0 0 1 27 4 0 8 4 1 6 3 1 17 0 1 16 0 58 23 12 23 0

17 0 5 0 1 11 78 11 5 28 9 0 9 10 6 92 0 8 84 0 52 20 12 20 1

5 0 0 0 0 5 59 1 3 15 14 3 5 15 3 87 0 3 84 0 51 15 10 26 0

0 0 0 0 0 0 3 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 1 0 0 0 1 20 2 1 10 4 1 1 0 1 47 0 5 42 0 0 0 0 0 1

6 0 1 0 1 4 30 1 2 12 6 2 2 2 3 18 0 2 16 0 0 0 0 0 0

4 0 2 0 0 2 23 2 2 4 6 0 8 1 0 38 0 2 36 0 0 0 0 0 0

7 0 1 0 0 6 46 5 2 10 5 0 1 20 3 71 0 1 70 0 0 0 0 0 0

3 0 1 0 0 2 12 2 1 4 2 0 1 2 0 4 0 0 4 0 0 0 0 0 0

1 0 0 0 0 1 3 0 0 0 0 0 1 0 2 1 0 1 0 0 103 35 22 46 0

1

0

1

0

1

0

0

0

0

0

1

0

Skin 47 Melanoma 44 Other 3 Breast 126

39 37 2 105

8 7 1 21

34 31 3 8

13 13 0 118

3 3 0 18

18 18 0 47

10 10 0 34

2 2 0 12

4 3 1 9

8 7 1 6

2 1 1 0

45 12 20 11 0 2 93 92 1 0 39 35 4 0 24 0 7 17 23 20 3 38 2 36 22

36 7 18 9 0 2 59 59 0 0 27 25 2 0 18 0 3 15 21 20 1 22 2 20 22

9 5 2 2 0 0 34 33 1 0 12 10 2 0 6 0 4 2 2 0 2 16 0 16 0

0 0 0 0 0 0 93 92 1 0 32 29 3 0 8 0 2 6 8 7 1 17 1 16 14

45 12 20 11 0 2 0 0 0 0 7 6 1 0 16 0 5 11 15 13 2 21 1 20 8

0 0 0 0 0 0 0 0 0 0 13 13 0 0 0 0 0 0 0 0 0 0 0 0 0

19 8 8 2 0 1 7 6 1 0 8 6 2 0 0 0 0 0 15 15 0 8 1 7 0

2 0 0 2 0 0 70 70 0 0 9 9 0 0 0 0 0 0 1 1 0 7 0 7 0

13 1 6 5 0 1 2 2 0 0 0 0 0 0 0 0 0 0 2 2 0 4 0 4 0

5 1 2 2 0 0 5 5 0 0 2 2 0 0 0 0 0 0 2 2 0 16 1 15 0

6 2 4 0 0 0 9 9 0 0 7 5 2 0 0 0 0 0 0 0 0 2 0 2 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 24 0 7 17 3 0 3 1 0 1 22

1

1

0

1

0

0

0

0

0

0

0

1

Connect/Soft Tissue

Female Genital Cervix Uteri Corpus Uteri Ovary Vulva Other Male Genital Prostate Testis Other Urinary System Bladder Kidney/Renal Other Brain & CNS Brain (benign) Brain (malignant) Other Endocrine Thyroid Other Lymphatic System Hodgkin’s Disease Non-Hodgkin’s Unknown Primary Other/Ill-Defined



N/A

AJCC Stage Group N/A

Number of cases excluded: 1 This report EXCLUDES CA in-situ cervix cases, squamous and basal cell skin cases and intraepithelial neoplasia cases

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Many Faces of Cancer. One Center for Hope. Site Distribution Bronchus & Lung

Breast

9.62%

Prostate Gland

Colon

Skin

9.41% 35.15%

19.25% 26.57%

Breast

Colon

Rec

2010 Estimated Performance Rates

12

Radiation therapy is considered or administered within 6 months of diagnosis for patients under the age of 80 with clinical or pathologic AJCC T4N0 M0...

100

At least 12 regional lymph notes are removed and pathologically examined for resected colon cancer.

76.5

Adjuvant chemotherapy is considered or administered within 4 months of diagnosis for patients under the age of 80 with AJCC Stage III...

100

Tamoxifen or third generation aromatase inhibitor is considered or administered within 1 year of diagnosis for women with AJCC T1c N0 M0, or Stage II or III...

100

Combination chemotherapy is considered for administered within 4 months of diagnosis for women under 70 with AJCC T1c N0 M0 or Stage II or...

100

Radiation therapy is administered within 1 year of diagnosis for women under age 70 receiving breast conserving surgery for breast cancer.

100

Many Faces of Cancer. One Center for Hope. Breast Cancer Data Review

Jeffrey Brabham, MD Radiation Oncology

Each year, the Florida Hospital Waterman Cancer Institute team selects a commonly treated cancer to examine in more detail. Specifically, we aim to review national data regarding treatment patterns and outcomes for this cancer and compare our own institutional data to these standards. Through this process, we strive to demonstrate that care at Florida Hospital Waterman Cancer Institute is comparable to national benchmarks and, should this ever not be the case, use the data to strategically improve our own processes. Among women, breast cancer is the most common cancer in the United States. It’s the number two cause of cancer mortality trailing only lung cancer, and accounts for one quarter of all cancer deaths. The American Cancer Society estimates approximately 230,000 new cases of breast cancer will be diagnosed this year. At Florida Hospital Waterman Cancer Institute, these figures translated into 105 patients diagnosed with and treated for breast cancer in 2010. Review of the Institute’s data in comparison with benchmark institutions between 2000 and 2009 (Figure 1) illustrates the patient population was older at diagnosis than national norms. This fact is not surprising given the population characteristics of the primary service area, but nonetheless does occasionally impact the treatments offered to patients and, ultimately, observed survival. Like most cancers, the prognosis and treatment for breast cancer depends largely on its stage at diagnosis. Review of the Institute’s data in comparison to benchmark institutions between 2000 and 2009 indicate that the distribution of breast cancer stage at diagnosis is similar to national norms (Figure 2). Given this fact, examination of the frequency of the treatment modality combinations in comparison to national norms (Figure 3) is particularly interesting, as it reveals a much higher frequency of radiation therapy use in conjunction with surgery, with or without the use of systemic therapy. This fact suggests more women are offered breastconserving therapy at Florida Hospital Waterman Cancer Institute than at similar institutions around the nation. Given the frequency of radiation therapy usage at Florida Hospital Waterman Cancer Institute, a more in-depth study of the Institute’s use of various radiation techniques was conducted (Figure 4). This data illustrates the frequency with which physicians are able to offer accelerated partial breast irradiation (ABPI) to our patients, almost always with the SAVI ® device, allowing a majority of our breast patients to receive the benefits of breast conserving therapy in only five treatment days.

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Many Faces of Cancer. One Center for Hope. Finally, the Institute’s data was reviewed in comparison to benchmark institutions for five-year observed survival of our breast cancer patients, stratified by stage, between 2003 and 2006 (Figure 4). This analysis confirmed Florida Hospital Waterman Cancer Institute’s outcomes are comparable to the outcomes seen in breast cancer patients of similar stage nationwide, keeping in mind the impact of an older patient population on these figures. In conclusion, this review of the patient population and outcomes data here at Florida Hospital Waterman Cancer Institute indicate outcomes matching those of regional and national benchmarks, despite having an older population at diagnosis. Moreover, the data suggests a greater percentage of patients are able to receive breast-conserving therapy, particularly with the convenience of the ABPI technique, than patients at similar institutions nationwide. These figures demonstrate the quality of care provided at Florida Hospital Waterman Cancer Institute. It is a privilege to serve the cancer needs of Lake County and Florida Hospital Waterman Cancer Institute will continue to review and improve the processes necessary to provide patients with the best oncology care possible.

Figure 1

Figure 2 Stage of Breast Cancer Diagnosed in 2000 to 2009 Florida Hospital Waterman vs. Comprehensive Hospitals in All States

30 25 20 15 10 5 0

Florida Hospital Waterman (%) Other

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Percentage

Percentage

Age Group of Breast Cancer Diagnosed in 2000 to 2009 Florida Hospital Waterman vs. Comprehensive Hospitals in All States

Under 20-29 20

30-39

40-49

50-59

60-69

70-79

80-89 90 and over

40 35 30 25 20 15 10 5 0

0

0

1.81

10.06

17.68

24.9

28.39

14.97

2.19

Florida Hospital Waterman (%)

0.01

0.34

3.82

17

23.96

22.97

19.9

10.59

1.4

Other

0

I

II

17.16

38.06

24.26

20.41

38.91

25.7

III

IV

NA

UNK

7.87

5.16

0.13

7.35

7.43

3.34

0.09

4.12

Many Faces of Cancer. One Center for Hope. Figure 3 First Course Treatment of Breast Cancer Diagnosed in 2009 Florida Hospital Waterman vs. Comprehensive Hospitals in All States

Percentage

40 30 20 10 0

Florida Hospital Waterman

Other

Surgery Only

Surgery & Hormone Therapy

Surgery & Radiation

Surgery, Radiation, Chemotherapy & Hormone Therapy

Surgery & Chemotherapy

Surgery, Chemotherapy & Hormone Therapy

Surgery, Radiation & Chemotherapy

Other Specified Therapy

Surgery, Radiation & Hormone Therapy

No 1st Course RX

Figure 4

Breast Cancer Observed Survival Rate Florida Hospital Waterman National AJCC 6h Edition 100 90

Percentage

80 70 60 50 40 30 20 10 0

Stage 0

I

Stage 1

Stage 2

Stage 3

Stage 4

Florida Hospital Waterman (%)

92.8

87.8

73.1

66.1

23.5

National

95.6

92.1

85.2

66

21.9

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4000 Waterman Way, Tavares, FL 32778 (352) 253-3600 www.fhwat.org/care-and-services/cancer-institute